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Rahim Yar Khan health initiative – revisited

Published in The News International on August 06, 2006: Perhaps no other health policy intervention in recent times has been the substrate of a greater controversy compared with restructuring the mode of primary health care service delivery in Rahim Yar Khan (RYK) as part of which the management of Basic Health Units, in twelve districts of the country, was handed over to the Punjab Rural Support Program in Punjab, beginning 2003. True that an overview of health policy and regulation in Pakistan can highlight many sore spots; the generic drug scheme of 1973, partial deregulation of prices of drugs in 1993, the institutional based private practice fiasco in NWFP in 2002 and the more recent PMDC scuffle are examples of contentious policy issues. However what makes the RYK initiative unique is the length of time for which the controversy prevailed, the utter discord in professional opinion on envisaged merits and demerits, the lack of consensus over how the initiative needs to be contextualized in the overall context of health reforms within the country, lack of full ownership of the State's...

Playing health with a new stack of cards

Published in The News International on July 02, 2006: 'Playing health' with a new stack of cards The planet earth's environmental and ecological transformation is a subject of much ado as are the contemporary concerns around the power dynamics, which will determine the global epicenter economically, militarily and politically over next two to three decades. This is justifiably a subject of critical thinking and planning. But sadly, the implications of this makeover for the social sector remain largely unrecognized. In the health sector more specifically, the thinking that health needs to be delivered as a public good – modeled on the Alma Ata ethos – still holds ethical merit backed by constitutional legitimacy and state commitment as in many developing countries; this model is also being followed in Pakistan where the delivery of health is seen as a state prerogative with the state attempting to provide health for all. How the booming market dynamics play into this calculation, how vested interests, profit margins and the omnipresent role of the private sector cut across this paradigm, how a globalized world impacts...

Budget 2006-07 – an ode to health

Published in The News International on June 30, 2006: Flagging a 21.3% increase in the budgetary allocation for health as part of the unprecedented increase in the development expenditure in the fiscal budget of 2006-07, the recital of June 5, 2006 made a reference to health as being a provincial subject. True that health is a provincial subject and true that the provinces – and now under the Local Government Ordinance of 2001, the Districts – have legal responsibility to deliver services. But then the federal government has constitutional prerogatives relating to health, which have important fiscal implications both at the provincial and district levels as well as within the overall ambit of federal programs in the health sector. Evidently, increases in budgetary allocations are a sine-qua-non of improving health outcomes. But clearly not the only! As the most complex of the social sectors, health necessitates in tandem systems and financing restructuring, for which budgetary allocations can act as the key tool in addition to being the critical input. With this as a context, three questions have been addressed within the...

The Health Budget 2006 – the policy context

Published in The News International on June 06, 2006: Budget 2006 is just around the corner with an indication that there would, both, be aggregate as well as program-specific enhanced allocations for health. This raises the question of whether these can translate into improved health outcomes over the short term. Here it must be understood that the relationship of health indictors does not necessarily parallel the level of resource inputs particularly if considerations relating to the utilization of funds and a reconfiguration of the health system are not brought to bear. Within this context, three questions emerge: how should we interpret and analyze the current allocations – per se; do we need to focus on how budgets can be utilized better and do we need alternate modes of health financing, and if so, why? Firstly, interpreting the ballpark figures:  the Government of Pakistan has been spending 0.6 to 1.19% of its GDP and 5.1 to 11.6% of its development expenditure on health over the last 10 years. However, these figures reflect spending by the Ministry of Health and the departments...

The Public-private interface: more than – a driver of economic growth

Published in The News International on May 28, 2006: Changes in public-private roles are interlinked with broader changes in the macro-economy. Limitations of centrally planned economies, the resultant privatization of State-owned enterprise accentuated by fiscal constraints and donor conditionalities have continued to promote a package of measures in the developing countries, which make private sector the engine of growth. The current Government of Pakistan polices hinge on this concept and have forged 'partnerships' with the private sector in order to finance infrastructure needs of the country and open new sectors on the premise that the role of the State is to provide a policy, regulatory and legal environment. Within this context the recent title of Pakistan's Development Forum "Drivers of Economic Growth: Unleashing the Potential of the Private Sector" was relevant given that it underscored the realization that many considerations have – and will continue to – automatically move back the borders of the State, reshaping the way the government does business. However, it must be recognized that these considerations also impact the discourse over public goods and the role...

Global Consortium on Community Health Promotion.

Nishtar S, Perry M, Lammare MC, Ritchie J. Global Consortium on Community Health Promotion. Promotion and Education...

Social Health Insurance in NWFP – the steps ahead

Published in The News International on April 30, 2006: A news feature in The NEWS on April the 4th has outlined the NWFP Department of Health's intent to launch a social health insurance scheme for the province. Aimed at improving access of the marginalized to health services, this is, in principle, a step in the right direction as it potentially offers a 'health systems' rather than an ad hoc solution. It is envisaged that if the strategy is appropriately structured, it can obviate some of the equity issues that have arisen from the currently prevailing tertiary-care-heavy health financing patterns. The articulation of this intent is also reflective of a bilateral donor agency's proactive role in supporting health reforms and the strategic institutional support they have provided to the NWFP Health Sector Reform Unit, which amongst other things has primed policy makers to systems solutions. While the NWFP Department of Health needs to be lauded for it's out-of-the-box thinking, it is also opportune to remind them of some of the overarching considerations that must be borne in mind while they...

Civil Service Reforms–the move from hype-to-hope

Published in The News International on April 09, 2006: Civil service reforms need to be an integral part of social sector reform processes if sustainable solutions to currently existing issues within the ambit social sector service delivery are envisaged. Within this context, there seems to be some justification for the perception that civil service reforms may finally be part of a mainstream agenda in Pakistan. This is evidenced by the initiation of processes such as the creation of a Committee for Civil Service reforms, the establishment of a Civil Service Reform Unit in the Establishment Division, launching of the Professional Development Agenda and the more recent announcement of the reform package for introducing good governance in the country by the Ministry of Law and signaling the importance of this area of reform by soliciting help from the multilateral development agencies. However, given that this is not the first time efforts are underway in this area, tipping the balance from the hope-to-hype equation will depend on the manner in which a strategic approach prevails – both in intent and in...

Avian Flu – the short and long term contexts

Published in The News International on March 05, 2006: Given that diseases such as the Plague, SARS, HIV/AIDs and Avian Flu do not respect national boundaries, the news of Avian Flu in our immediate neighborhood, left a slim choice between treading the prevent-prepare-control options a week ago. However its detection on an NWFP farm yesterday, made choices much clearer. Ever since Avian Influenza (H7N3) hit Pakistan in 2003-04 and was subsequently curbed at source in the agriculture and health sector through implementation of animal and human health surveillance, disease control and mitigation measures, some level of gearing up for another outbreak had been witnessed. Evidenced by news and other forms of reporting, efforts included the establishment of surveillance laboratories equipped to diagnose bird flu; enhanced allocations for strengthening surveillance and emergency preparedness and clinical, serological, and virological surveillance in migratory birds from different parts of the country. It is hoped that these investments will pay off given the recent emergence of the virus in NWFP. However, the situation specific to Avian Flu and the earlier experience relating to the health...

Pakistan Medical and Dental Council – strategic imperatives

Published in The News International on February 08, 2006: Recent controversies around the Pakistan Medical and Dental Council (PMDC), the efforts presently underway to break the resulting stalemate and more topically offered solutions now favoring a major overhaul highlight an opportunity to flag some fundamental questions about the role of this institution. Mandated with a normative and regulatory role within the ambit of the medical profession, PMDC is a statutory autonomous organization. The PMDC Ordinance of 1962 and the subsequent amendments introduced in 1967 and 73 provide a policy framework enabling it to set standards of medical education, register practitioners and accredit academic medical establishments. But is this all that needs to be within the PMDCs remit? Or should its role be broader given that this is the only body that regulates the medical profession? If considerations of protecting, promoting and maintaining the health and safety of the patients are brought to bear – as they should given that they are the cornerstones PMDC's code of ethics – perhaps there is a need for revisiting its scope. These bring...

Improving heart health in Europe.

Nishtar S. Improving heart health in Europe. Circulation 2006;113(4):f16 Download Attached file #...